Provider Demographics
NPI:1942277934
Name:FUGATE, LEONARD CURTIS JR (PA)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:CURTIS
Last Name:FUGATE
Suffix:JR
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3209 SOLUTIONS CENTER
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-0001
Mailing Address - Country:US
Mailing Address - Phone:502-212-4759
Mailing Address - Fax:502-471-2051
Practice Address - Street 1:245 FOUNTAIN CT FL 1
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2792
Practice Address - Country:US
Practice Address - Phone:859-218-2626
Practice Address - Fax:859-257-3322
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA799363AM0700X, 363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY95003877Medicaid
KYP00459649OtherRAILROAD MEDICARE
KYP97703Medicare UPIN
KY0954005Medicare ID - Type Unspecified